The “Sports physical,” or “Preparticipation physical evaluation,” is an evaluation to identify conditions that predispose your child athlete to a higher risk of injury, illness, and even death. Preparticipation physicals are mandated in nearly every organized athletic program and are performed with the intent of identifying any condition that may preclude an athlete from safely participating in athletic events. It is important to utilize this opportunity to screen athletes for physical and or psychological ailments that may warrant further workup and treatment by other healthcare professionals.
An appropriate preparticipation physical examination is composed of the following components:
Medical and Family History
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- Your pediatrician will get a thorough history about any personal history of chest pain, syncope, fatigue, murmurs. They will investigate a family history of premature death, disability from heart disease, and/or cardiac conditions. This is particularly important as it is not uncommon to find potentially dangerous cardiac abnormalities in an otherwise asymptomatic youth, which are discovered only because a family history of such prompted a more thorough evaluation. A thorough history of medication use. This may include all medications and supplements taken by the athlete.
Physical Examination
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- General health screen: A general health of screen will include vital signs, height, weight, blood pressure, vision testing, pulmonary testing, neurological testing, abdominal testing, thorough skin examination, and examination of genitals which includes the presence of two testicles within the male athlete. It is not unheard of that an athlete somewhere within the country is found to have an undescended testicle on their sports preparticipation physical and, in so doing, is potentially saved from the possibility of testicular carcinoma.
- Cardiovascular screening: Cardiovascular screening will assess for heart murmurs, femoral pulses, and blood pressure measurements. Additionally, the exam will assess for marfanoid stigmata. Cardiac abnormalities that become apparent upon an examination or by way of a review of either the athlete’s or family’s history should be sent for a cardiology evaluation.
- Neurologic screen: Athletes undergo a full neurological exam. Your pediatrician will inquire about a history of concussions, seizure disorders, spinal cord injuries, and cervical spinal stenosis. Such things as bilateral extremity numbness, recurrent stingers, and cervical pain are all warning signs that a more thorough workup of the cervical spine should likely occur.
- Orthopedic screen: Your pediatrician will perform examinations specific to any prior or current injuries and site-specific examinations of strength, range of motion, deformities, instabilities, and asymmetries. Each year, many preparticipation examinations find such things as chronic ligamentous injuries to the knee and shoulder that may have occurred but were never reported. These are found in conjunction with asking the child whether they have injured any aspect of their musculoskeletal system and disclosing exactly how it happened.
- General medical screening: If the medical history elicits any concern for chronic diseases such as diabetes or anemia, additional laboratory tests will be performed.
Nutritional Assessment
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- Assess the athlete’s nutritional status. Screen for disordered eating, particularly in female athletes and athletes who participate in a sport with a weight cut-off, such as wrestling.
Heat and Hydration Related Risk factors and Education
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- Encouraging the intake of at least 20 ounces of water one hour before game time and again half that much just before game time is always good advice
- Sickle Cell disease symptoms can be worsened with dehydration.
Mental Health Assessment
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- Your pediatrician will inquire about symptoms of sleep disturbances, level of interest in previously enjoyed activities, symptoms of guilt or worthlessness, fatigue or loss of energy, ability to concentrate, and suicidal or homicidal ideation. If there are any concerns further evaluation may be recommended.
Remember this evaluation should ideally be done by someone like your pediatrician who really knows your child’s health history. Most sports physicals involve the parent/child completing a form on the child’s current health history, past history and family history. Then the exam part is completed by the pediatrician who will first review and discuss with the family any concerns and then thoroughly examine the child. Education on hydration and safety/injury prevention by using appropriate protective gear is given to the family and child. Lastly your pediatrician will clear your child for the sport if all evaluations are negative. If further testing or evaluations are needed the child will be referred and sports clearance will be delayed. Remember the goal is to protect your child and prevent any major health problems on the field.
